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HomeLatest NewsQuality NewsNew Medicare Part D opioid overutilization policies for 2019

New Medicare Part D opioid overutilization policies for 2019

The Centers for Medicare & Medicaid Services (CMS) finalized new policies for Medicare drug plans to follow starting on Jan. 1, 2019. These policies involve further partnership with providers and prescription drug plans.

Providers are in the best position to identify and manage potential opioid overutilization in the Medicare Part D population. Medicare prescription drug plans can assist providers by alerting them about unusual utilization patterns in prescription claims. The new policies include improved safety alerts when opioid prescriptions are dispensed at the pharmacy and drug management programs to better coordinate care when chronic high-risk opioid use is present.

Part D plans commonly implement safety alerts (pharmacy claim edits) for pharmacists to review at the time of dispensing the medication to prevent unsafe utilization of drugs. These alerts include: seven-day supply hard safety limit for opioid naïve patients and opioid care coordination alert when the morphine milligram equivalent reaches or exceeds 90 per day.

For more information on the new policies, see the MLN Matters article.


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